Examinations
CPSA · Clinical examination · Musculoskeletal
Knee examination
Look → feel → move → special tests for the ligaments and menisci. A focused MSK exam following the look/feel/move framework.
Practise it out loudPosition: Patient supine, both knees exposed; observe standing/walking first.
The routine
Look
- 1Standing: valgus/varus, swelling, muscle (quadriceps) wasting; gait (antalgic)
- 2Supine: scars, effusion, erythema
Feel
- 1Temperature; effusion (patellar tap / sweep test); joint-line tenderness (meniscus); popliteal fossa (Baker’s cyst)
Move
- 1Active then passive flexion/extension; note range, crepitus, fixed flexion
Special tests
- 1Anterior/posterior draw & Lachman (cruciate ligaments)
- 2Valgus/varus stress (collateral ligaments)
- 3McMurray’s (meniscus)
Signs & what they mean
Positive anterior draw / Lachman, often after a “pop” and rapid effusionAnterior cruciate ligament rupture
Joint-line tenderness + positive McMurray’s + lockingMeniscal tear
Laxity on valgus stressMedial collateral ligament injury
Effusion, crepitus, reduced range, varus deformity in an older patientOsteoarthritis
To complete, I would…
- Examine the joint above (hip) and below (ankle)
- Assess neurovascular status
- Request weight-bearing X-rays ± MRI
OSCE tips
- Always examine the joint above and below.
- Lachman’s is the most sensitive ACL test.
- A rapid tense effusion after trauma suggests haemarthrosis (ACL/fracture).